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Evaluation of a pharmacist-managed methadone taper*
Katherine J Steineck1, Angela K Skoglund, Melissa K Carlson
11Department of Pharmacy, University of Minnesota Amplatz Children's Hospital, Minneapolis, MN. 2Department of Pharmacy, University of Minnesota Medical Center, Minneapolis, MN. 3Division of Pediatric Critical Care Medicine, University of Minnesota Amplatz Children's Hospital, Minneapolis, MN.
Insights
A pharmacist-managed methadone taper protocol significantly reduced the time to discontinue opioids in pediatric patients. This optimized approach also decreased opioid infusion duration and potentially hospital length of stay.
Area of Science:
- Pediatric critical care
- Pharmacology
- Clinical pharmacy
Background:
- Opioid use in pediatric patients, particularly in intensive care settings, necessitates effective and safe discontinuation strategies.
- Methadone is a commonly used opioid for prolonged analgesia and withdrawal management.
- Optimizing methadone tapering protocols is crucial for improving patient outcomes and resource utilization.
Purpose of the Study:
- To evaluate the efficacy of a pharmacist-managed methadone tapering protocol compared to historical prescribing practices.
- To assess the impact of the protocol on the duration of methadone taper, opioid discontinuation, and hospital length of stay.
Main Methods:
- Retrospective chart review comparing patients before and after the implementation of a pharmacist-managed methadone taper protocol.
- Study included pediatric patients aged 1 month to 16 years undergoing opioid weaning.
- Data collected included taper length, additional opioid requirements, withdrawal scores, and hospital length of stay.
Main Results:
- The pharmacist-managed protocol significantly reduced the average methadone taper length from 24.7 to 15 days (p = 0.0026).
- Opioid infusions were discontinued sooner by an average of 1.54 days in the intervention group (p = 0.0039).
- A statistically significant decrease in hospital length of stay was observed in the group managed by the protocol (p = 0.023).
Conclusions:
- A pharmacist-managed, protocolized methadone taper is an effective strategy for expediting the discontinuation of opioids in pediatric patients.
- Implementation of this protocol can lead to earlier cessation of opioid infusions and potentially reduce overall hospital length of stay.
- This protocol represents an effective method for weaning pediatric patients from opioids in a quaternary care setting.
Objectives:
To evaluate the efficacy of a pharmacist-managed methadone taper as compared to previous prescribing practices.
Design:
Retrospective chart review with comparison to historical controls.
Setting:
Ninety-six-bed pediatric quaternary care facility with the majority of the patients in a 24-bed ICU.
Patients:
Thirty-two patients, 1 month to 16 years old, weaned off opioids using methadone prior to protocol initiation were compared with 20 patients, 1 month to 15 years old, weaned per the pharmacist-managed methadone taper protocol.
Interventions:
Implementation of a pharmacist-managed methadone tapering protocol.
Measurements And Main Results:
Patient age, gender, weight, and risk of withdrawal were similar between the groups (p = not significant). The average taper length before pharmacist intervention was 24.7 days; after implementation it was 15 days (p = 0.0026). There was no statistical difference in the number of additional doses of opioid required or withdrawal scores between the populations. Opioid infusions were stopped, on average, 1.54 days sooner in the intervention group (p = 0.0039). A decrease in hospital length of stay was also seen in the intervention group (p = 0.023).
Conclusions:
A pharmacist-managed protocolized methadone taper facilitates discontinuing methadone sooner, discontinuing additional opioid infusions sooner, and may impact on the length of hospital stay. The protocol developed at the University of Minnesota Amplatz Children's Hospital has demonstrated that it is an effective method to wean pediatric patients from opioids.
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